Late-Onset Hemorrhagic Cystitis Associated With Urinary Excretion of Polyoma Viruses After Bone Marrow Transplantation

Apperley, JF; Rice, S J; Bishop, J A; Chia, Yook Chin; Krausz, T; Gardner, S. D.; Goldman, JM

doi:10.1097/00007890-198701000-00024

Cited by 120 publications

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“…HC occurring late after HSCT is unlikely to be due to the conditioning regimen, and therefore probably has another pathogenesis. Associations with BK virus [7][8][9][10] or adenovirus type 11, 11-13 acute or chronic GVHD, 14,15 and chemotherapeutic agents 16,17 have been demonstrated in late-onset HC. In particular, some observations suggested an association HSCT = hematopoietic stem cell transplantation; CY = cyclophosphamide; BU = busulphan; MEL = melphalan; TBI = total body irradiation; GVHD = graft-versus-host disease; CyA = cyclosporin A; ATG = anti-thymocyte globulin; mPSL = methyl-prednisolone.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][6][7][8][9][10][11][12][13][14][15][16][17] Most previous reports did not distinguish early-onset HC from late-onset HC, and this could be one reason for the relatively low incidence in our series. However, we suspect that patient age is more important with regard to this point.…”

Section: Tablementioning

confidence: 99%

“…Several factors, including viral reactivation, [7][8][9][10][11][12][13] graftversus-host disease (GVHD), 14,15 and chemotherapeutic agents, 16,17 have been implicated as causes of HC. HowCorrespondence: Dr M Kondo, Department of Pediatrics, Nagoya University School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan Received 9 April 1998; accepted 15 July 1998 ever, most reports included all cases developing HC, and few focused on late-onset HC alone.…”

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confidence: 99%

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Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children

Kondo

Kojima²,

Kato³

et al. 1998

Bone Marrow Transplant

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Summary:We analyzed the incidence, complications, and risk factors for late-onset hemorrhagic cystitis (HC) in 256 children undergoing hematopoietic stem cell transplantation (HSCT). Twenty-six recipients (10.2%) developed late-onset HC between 3 and 270 days (median, 33 days) after HSCT. In most patients, the severity of HC was mild to moderate, and spontaneous resolution occurred. Three children developed bladder tamponade, and one required suprapubic cystotomy. Four children died in the early post-transplant period without resolution of HC, but HC was not the direct cause of death in any patient. Twenty-two patients recovered within 6-86 days (median, 16 days) of onset. Three predisposing factors were identified for development of late-onset HC by multivariate analysis: allogeneic HSCT, older age (у7 years), and busulphan for pretransplant conditioning were significantly associated with late-onset HC (P ‫؍‬ 0.022, P ‫؍‬ 0.044 and P ‫؍‬ 0.036, respectively). Excretion of adenovirus type 11 was demonstrated in six of 22 patients at the onset of cystitis. We suspect that reactivation of virus may be a major pathogenic factor in lateonset HC, but several clinical factors are also associated.

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Section: Discussionmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

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confidence: 99%

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Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children

Kondo

Kojima²,

Kato³

et al. 1998

Bone Marrow Transplant

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“…1 Reactivation following BMT has been reported to be associated with haemorrhagic cystitis (HC). [2][3][4][5][6][7][8][9] HC is a serious post-transplant complication associated with significant morbidity. However, the relation between HC and polyoma virus remains contentious because not all patients who reactivate the virus develop HC.…”

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confidence: 99%

Polyoma viruria following T-cell-depleted allogeneic transplants using Campath-1H: incidence and outcome in relation to graft manipulation, donor type and conditioning

Chakrabarti

Osman

Collingham

et al. 2003

Bone Marrow Transplant

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“…5,6 Seber et al 1 have reported that risk factors for HC in allogeneic transplant patients include grade II-IV GVHD, use of Bu, and age of 10 to 30 years at transplantation. Although they did not find any significant association between the risk of HC and the dose of CY, the metabolites of CY are well-known causes of HC.…”

Section: Discussionmentioning

confidence: 99%

Successful hyperbaric oxygen treatment of life-threatening hemorrhagic cystitis after allogeneic bone marrow transplantation

Hattori

Yabe

Matsumoto

et al. 2001

Bone Marrow Transplant

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Summary:Hemorrhagic cystitis (HC) is a major cause of morbidity after allogeneic bone marrow transplantation (BMT). Many therapies have been investigated to prevent or treat HC, but effective treatment for HC is still limited. While the efficacy of hyperbaric oxygen therapy has been established for HC due to chemotherapy and/or radiation therapy, its role in HC occurring after allogeneic BMT has yet to be defined. We report two cases of life-threatening late-onset HC after allogeneic BMT in children, which resolved after treatment with hyperbaric oxygen. Bone Marrow Transplantation (2001) 27, 1315-1317. Keywords: hemorrhagic cystitis; hyperbaric oxygen; allogeneic bone marrow transplantation; children Hemorrhagic cystitis (HC) is a major complication following hematopoietic stem cell transplantation. Severe cystitis has been reported to occur in about 5% of bone marrow transplant (BMT) patients. Allogeneic BMT, grade II-IV graft-versus-host disease (GVHD), use of busulfan (Bu), age at transplantation and adenovirus infection increase the risk of severe HC. 1 Many therapeutic approaches have been tried to control pain and bleeding due to HC; despite this, HC can lead to bladder tamponade requiring surgical intervention, and can contribute to death. Hyperbaric oxygen (HBO) therapy has been used extensively in hypoxic tissue in an attempt to stimulate angiogenesis and prompt healing. HBO has been used successfully in the treatment of radiation or cyclophosphamide (CY)-induced HC. 2,3 This is the first report in patients with intractable HC after allogeneic BMT who were controlled by HBO. Case histories Case 1An eight-year-old boy with acute lymphocytic leukemia in third remission underwent BMT from an HLA-matched unrelated donor in June 1998. He received a conditioning regimen of Bu 4 mg/kg/day for 4 days, CY 60 mg/kg/day for 2 days, and etoposide 60 mg/kg/day for 1 day. Cyclosporine A (CsA) and prednisolone were administered for GVHD prophylaxis. The clinical course after BMT is shown in Figure 1. By the fifth week after BMT, trilineage engraftment was confirmed. The patient did not develop acute GVHD. At day +4 he had developed dysuria, suprapubic pain and macrohematuria. On day +70 he developed gross hematuria with clots and an abundant residue of bladder mucus. Adenovirus was not cultured from the urine, and HC was not attributed to polyomavirus infection because characteristic morphologic changes in the urinary sediment were not seen in conjunction with the urine culture being negative for other pathogens. During the next 9 weeks, gross hematuria continued, and the patient required seven transfusions of packed red blood cells and 33 transfusion of platelets. Despite conservative treatment with continuous bladder irrigation and intravesicular maalox and prostaglandin E1 (PGE1), he developed bladder tamponade on days +78 and +118 after BMT requiring emergency cystostomy and evacuation of hematomas. Post-renal failure developed, and he was referred for HBO therapy after bilateral tympanostomies. The patient was ...

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Late-Onset Hemorrhagic Cystitis Associated With Urinary Excretion of Polyoma Viruses After Bone Marrow Transplantation

Cited by 120 publications

References 0 publications

Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children

Late-onset hemorrhagic cystitis after hematopoietic stem cell transplantation in children

Polyoma viruria following T-cell-depleted allogeneic transplants using Campath-1H: incidence and outcome in relation to graft manipulation, donor type and conditioning

Successful hyperbaric oxygen treatment of life-threatening hemorrhagic cystitis after allogeneic bone marrow transplantation

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